Endoscopic pilonidal sinus treatment: A minimally invasive surgical technique

Abstract

Introduction Pilonidal sinus disease (PSD) is a common skin and subcutaneous disease that is mainly seen in men (mean age, 30 years); its incidence rate is 26 cases per 100 000. PSD greatly affects quality of life. Ideally, a surgical procedure to treat PSD should involve a minimal hospital stay and require minimal time off work, discomfort, operative time, and cost; it should also limit recurrence. In this study, we present a new minimally invasive technique for pilonidal sinus surgery known as endoscopic pilonidal sinus treatment (EPSiT). Methods From February 2017 to April 2019, 100 patients diagnosed with PSD were treated with the EPSiT method at the Department of General Surgery, Imam Reza Hospital. Patient information was recorded prospectively. During the operation, the fistula cavity and tracts were ablated by an electrode that was introduced through the operative channel. All the epithelial and granulation tissues were removed by a brush inserted into the operative channel or by a Volkmann spoon. Results None of the patients had postoperative complications, such as hematoma, seroma, or wound infection, during the follow‐up period. Recurrence was seen four patients (4%). At 1 week postoperatively, the visual analog scale score was 3 for 37 patients (37%) and 2 for 28 patients (28%). The maximal cosmetic satisfaction rate was reported in 85 patients (85%). Conclusion As a minimally invasive procedure, EPSiT is effective for treating PSD. Compared with excision and primary closure techniques, EPSiT has a very low recurrence rate after the procedure and a short hospital stay.

Endoscopic Pilonidal Sinus Treatment: A Tertiary Care Academic Center Experience

“…The results of the present study are consistent with those described in the current literature ( Table 5 ) ( 7 , 9 , 14 , 16 – 24 ).…”

Long‐term efficacy of endoscopic pilonidal sinus treatment: a single‐centre Australian experience

“…The vast majority were able to return to normal activities the following day. These outcomes were comparable to other studies of EPSiT 11,19,20,[23][24][25][26][27] and were a significant improvement on the morbidity associated with more invasive procedures 9,10,23 where hospitalization can exceed 10 days and return to work even longer. These are important points as a potential barrier to uptake of EPSiT is the upfront cost (list price $15000) however the authors considered the cost minimal in comparison to the global cost reduction of reduced hospitalization, complications, time of work, and consumables such as dressings and medication.…”

“…Healing was however significantly lower than in studies with shorter follow up durations (1-2 years). These studies 11,19,[24][25][26][27] demonstrated primary healing rates of between 92% and 96% suggesting a certain amount of long-term recurrence is associated with EPSiT. Median time for complete healing was 6 weeks (IQR 6.5).…”

Comparative analysis on the effect of the endoscopic versus conventional treatment for pilonidal sinus: A meta-analysis of controlled clinical trials

“…Since then, many researchers have conducted prospective or retrospective studies on endoscopic treatment for pilonidal sinus. These studies [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] showed that endoscopic therapy was a safe, minimally invasive, and less complicated treatment method, but most were single-arm experiments. Therefore, we need more prospective randomized trials with adequate long-term follow-up to improve the body of evidence.…”